An RCT to assess effectiveness of the in-home Growth Monitoring Tool (GroMoTo) in addressing chronic childhood undernutrition in Pakistan

We hypothesize that poor caregivers do not receive frequent and timely feedback on their child’s growth trajectory, which constrains their understanding of the relationship between different childcare inputs and growth. This is especially important for pockets of poverty where the majority of children may be short for their age i.e. the reference child that caregivers have (children from within their community) may also be stunted. Consequently, despite access to resources like information on optimal practices through public health information campaigns and nutrition counseling, caregivers typically do not translate this information into action by adjusting their inputs. Moreover, child development may come into focus only during the regular visits to their local clinic where such feedback can be sought, but these visits can be infrequent and irregular since clinics are often far away and ‘cost’ caregivers in time and money. According to the Multiple Indicator Cluster Survey 2014 in Pakistan, only 4% of HHs in the lowest wealth quintile sought care for their children at a clinic (UNICEF & Sindh Bureau of Statistics, 2014). Another constraint – albeit not necessarily unrelated – could be limited attention to child growth in poor households with taxed attentional capacity (World Bank, 2015). We propose a potential solution - a flexible and low-cost in-home growth monitoring tool called GroMoTo, coupled with counseling and/or (labeled) cash transfer. Fink, et al. (2017) test a passive version of this in Zambia and find positive effects on growth among undernourished children.